Wednesday, 15 July 2009

When "Cheers" becomes Fears - Alcohol in Pregnancy

I know that in general, drinking alcohol is a ‘no no’ in pregnancy. It doesn’t take an obstetrician or experienced mama to know that heavy drinking is strongly linked to babies with Fetal Alcohol Spectrum Disorders (FASD) or full blown Fetal Alcohol Syndrome. I'd be reckless to put my unborn child at such risk.

Yet here in the UK I have heard and read that light drinking during pregnancy is not clinically proven to precipitate ill effects in babies. The definition of "light drinking" is hazy, but the general understanding is that if you employ common sense and have, say, one drink/week, there is no evidence to show you will be doing your child a disservice. Is there still a slight risk involved? Yes. But there is a risk in doing pretty much everything when you are pregnant: eating a hot dog at a baseball game, stretching before and after exercise, crossing the street on unsteady feet with a big belly……

I thought this seemed like sensible advice, so throughout my first trimester I had a sip, or small glass of wine, now and again. Particularly before we broke our news, this was an easy way to keep suspicion at bay. It’s not like I’m a heavy drinker, but when girls my age who usually enjoy a glass of wine at the pub after work turn to OJ and start making excuses about being on antibiotics, covers are quickly blown.

When I was recently in NY on vacation I received my own sacred copy of Heidi Murkoff’s ‘What to Expect When You're Expecting.’ Woooeee! Heidi is the goddess of pregnancy advice and I am finding her book very helpful, however, her commentary on alcohol in pregnancy freaked me out! I can’t remember the advice verbatim, but it was something to the affect of “You should not drink at all during pregnancy. The alcohol in your system will cross the placenta and will have harsher effects on your baby than you – so you may not even feel buzzed, but your baby could be drunk!” Oh crap.

I thought I’d been so careful. I felt guilty and concerned. Then the fear set in and I started counting up the number of drinks I’d had over the previous weeks and asking my friends and family if they thought baby would be alright. Everyone agreed they thought I was fine. Some commented they’d heard it’s safer to drink lightly after the first trimester, but first trimester was where I was. Ironically, those on both sides of the pond, including Heidi, tell you not to worry about the alcohol you drank before you were pregnant. Well some girls would probably have drunk more without knowing than I did while in the know! But fear wreaks havoc with logic.

I’m pleased to say that after my initial guilt/fear, I didn’t freak and concluded rationally that what was done was done. But I did tell myself that I’d probably not drink at all going forward, and if I did, only in little sips. Heidi’s words had made their mark.

Since returning to England I’ve done some reading on the respective attitudes/advice toward alcohol consumption in pregnancy in both the UK and USA. Experts from both call for abstinence with regard to alcohol, however it seems this zero tolerance attitude is born more out of the uncertainty that surrounds light drinking in pregnancy rather than any actual grim fact. Bearing this in mind, the general advice and subsequent attitude toward alcohol in pregnancy seems more chilled out and less heavy handed in the UK. For example, check out the slightly contradictory commentary on 'Alcohol in Pregnancy' from versus These are excerpts but give the general gist/tone of the article:

“There is no doubt that heavy drinking, particularly binge drinking (five or more units of alcohol on one occasion), during pregnancy is not safe. It can seriously affect your developing baby.

The risks of drinking at much lower levels, however, are not clear cut. Nevertheless, it is now recommended that pregnant women completely abstain from drinking alcohol. Some experts recommend abstaining completely during the first three months, while others advise staying tee-total for the whole pregnancy.

If you do decide to drink during pregnancy, it is recommended that you limit your intake to no more than one or two units of alcohol, no more than once or twice per week. The RCOG advise women that there is no evidence of harm from drinking at this low level. However, binge drinking or getting drunk is dangerous for your developing baby.”

“Alcohol and pregnancy don't mix. No one knows exactly what harmful effects even the smallest amount of alcohol has on a developing baby.

All public health officials in the United States recommend that pregnant women, as well as women who are trying to conceive, play it safe by steering clear of alcohol entirely.

Expectant moms who have as little as one drink a week are more likely than non-drinkers to have children who later exhibit aggressive and delinquent behavior. poor growth (in the womb, after birth, or both), abnormal facial features, and damage to the central nervous system."

Although we are looking at the same organisation, it’s apparent that professional and cultural biases are reflected in each country's specific website. I should also note that the US site does not cite the studies that back up its remark on expectant moms drinking 1 drink/week.

On the flipside, check out this article from Zoe Williams, Guardian columnist who writes an ante-natal series. It's a little dated from 2007 but gives an amusing tirade about all the things pregnant women are NOT supposed to. Here's an excerpt:

"Physiologically and sociologically, it just does not make sense that small amounts of alcohol are bad for you when pregnant. As Dr Eric Jauniaux, professor of obstetrics and foetal medicine at the Royal Free hospital in London, points out: "Alcohol is mainly metabolised by the liver, and only what's left will be met by the placenta. The amount that could reach the foetus in a glass of beer or a glass of wine is negligible. I would be much more concerned with breastfeeding and drinking." Jauniaux, incidentally, has been studying transfer through the placenta for the past 20 years, is one of the leading national experts on the matter and yet is never quoted in connection with any of the scare stories you read on alcohol and unborn babies. And sociologically, of course, Jauniaux reminds us: "How long have people been drinking wine or beer, thousands of years?"

The full article made me laugh:

I don't know the right answer on this one. Are you surprised that I know of more girls who have drunk lightly in pregnancy in the UK than in the USA? Judging from the tone and content of advice given in each country, I’m not.

It seems reasonable to me that a small drink every now and then won't hurt based on the current research.....and that experts often use scare tactics to cover their backs should a preggars lady go haywire with drink. But as my brother in law, the trader, would say, it all comes down to "risk/reward." Is the reward of a drink worth the slim risk or will it cause more mental aggravation? For me it's probably not, but that's for each pregnant girl to decide.

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